Research Training Program in Dementia

Training Program Structure

Aims. The Brown Dementia Research Fellowship (Brown DRF) is designed to develop independent investigators in clinical dementia research. It builds on previous successful efforts in the Brown Department of Psychiatry and Human Behavior (DPHB) to integrate the efforts of a diverse group of researchers in geriatrics and dementia. The present DRF is also designed to utilize the teaching expertise and resources of existing training programs at Brown. The specific aims of the program are to:

Setting. Five of the hospitals and research centers affiliated with our Medical School will participate in the proposed Dementia Research Fellowship. The Brown DRF program will be administered through the Department of Psychiatry and Human Behavior (DPHB) at Brown Medical School. However, the training program will be composed of diverse faculty with strong backgrounds in dementia research and training from a number of Brown University departments. These include the Departments of Clinical Neuroscience (Neurology/Neurosurgery), Neuroscience, Molecular Biology, Medicine (Pathology), Psychology, and Public Health. The Center for Gerontology and its director, Dr. Besdine, will figure prominently in the training program. This exceptionally diverse faculty will ensure that fellows receive training in all aspects of dementia research, from basic neuroscience to clinical assessment and treatment. The close working relationships previously established among these researchers will facilitate coordination of the program. All the participating groups are within easy driving distance of the Brown campus. The DPHB hosts some of the most highly regarded psychiatry, geriatric psychiatry, and neuropsychology training programs in the country. These programs attract outstanding, academically oriented trainees in the country, and will serve as a feeder system for the proposed dementia fellowships. The existing Brown T32 and General Fellowship programs will also provide some of the structure for didactic research training, complementing the dementia-focused didactics of the DRF. Administration of the proposed dementia research fellowship will be modeled on these successful fellowship programs.

Individualized training plan. The training experience is structured to provide individualized research experience and training, complemented by a common didactic curriculum to which 20% of fellows’ training time is allocated in Year 1. Each Friday will be set aside for seminars and informal interactions among the fellows and faculty. Academic Friday has been structured to maximize the likelihood for cross-fertilization and transdisciplinary thinking. One day per week in Year 1 will be devoted to dementia laboratory rotations. One other day each week during Years 1 and 2 will be spent in clinical practica in one of the Memory Clinics. The remainder of the week is spent doing research under the supervision of faculty mentors of their choice.

This basic program of research training and seminars can be supplemented by individualized formal course offerings available within the Medical School and the university when helpful to the training plans of individual fellows. For example, psychologists may require further training in neuropharmacology, whereas physicians may require more training in statistics and design.

Four weeks following the completion of the orientation program, the fellow will be required to submit a fully developed first year training plan to the Training Committee. This plan, developed in collaboration with each of the fellow’s chosen mentors, will describe the research plans of the fellow, including first year goals and the activities that the fellow will carry out to accomplish these goals.

Components of the training program. (a) Core Curriculum. All fellows will participate in a Core Curriculum coordinated by the Core Faculty, to ensure they have the essential knowledge of basic and clinical dementia research to succeed as independent investigators. The Core Curriculum will be completed via didactic seminars and hands-on, practical training experiences. Fellows will be evaluated on objective criteria to ensure their acquisition of Core Competencies in dementia research. The Core Curriculum will include the following areas:

Seminars and courses. Fellows in the proposed Dementia T32 program will be able to take advantage of established seminars in research techniques and ethics available to all T32 and F32 fellows at Brown. They will also be required to attend seminars taught by DRF faculty and designed to prepare them specifically for careers in dementia research. The Research and Ethics seminars occur on Friday mornings. The Dementia Research seminars and courses occur on Friday afternoons in two 90-minute sessions. The Grant Writing seminar occurs for 90-minutes on Monday afternoon throughout the year.

Mentored research. Mentored research and grant writing are the second core features of the training program. Fellows will be expected to produce an original research project and a grant proposal during their first year, under the direction of their basic and clinical mentors. The DPHB provides intramural support for these efforts.

Research themes. We have identified several themes that unify the current reseach of the basic and applied faculty. These include (a) Cerebrovascular changes in dementia; (b) Transgenic models of memory loss and dementia; and (c) Brain imaging in dementia. We have also described several clinical/applied areas in which our faculty has special expertise, and which fellows may choose to concentrate. These themes include: (a) Developing new treatments for dementia (b) Cognitive and behavioral predictors of functional decline.; and (c) Epidemiology and health services related to dementia.

Field clinical training. The Brown clinical training programs in clinical neuropsychology, geriatric psychiatry, geriatric neurology, and neuropsychiatry are nationally known for the quality of their training and academic success of their graduates. For fellows with clinical credentials (MD’s and clinical psychologists) who are interested in conducting treatment research, a part of their training experience may involve clinical activities with patients. In all cases, this is done under the supervision of certified and privileged clinical faculty. When this occurs, it is done as a means of facilitating the fellow’s development as a clinical researcher. The four Brown Memory Clinics provide ample opportunity for clinical experiences, including weekly multidisciplinary team meetings for consensus diagnosis and treatment planning. In addition, the Clinics will provide access to large patient populations for dementia research. The four clinics see over 1000 new patients per year.

Rounds. The affiliated hospitals and training programs present a variety of Grand Round experiences relevant to the training of dementia researchers. The usual format for Grand Rounds consists of a formal case presentation followed by a question and answer session. For example, the entire Brown University Neuropsychology community gathers weekly for Rounds in which the faculty, interns and postdoctoral fellows rotate making presentations. Typically, the trainees will make one presentation to the group during the year. Presentations can include case presentations, research presentations and discussions of professional issues. Some of the topics covered in the past few years have included spongiform encephalopathies, alcohol dementia, frontotemporal dementia, and ethical dilemmas specific to neuropsychology. Fellows will be encouraged to attend these rounds as time permits throughout their two-year training experience, with emphasis on discipline-specific experiences.